| NPI | 1659422558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A26396) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: HI 12249) |
| 208600000X Surgery (Licence: CA A26396) | |
| 208600000X Surgery (Licence: HI 12249) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2025-09-11 |